Absorbable Versus Non-Absorbable Sutures in Open Rhinoplasty: Analysis of Columellar Scarring.

INTRODUCTION: Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons. OBJECTIVE: This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons. MATERIAL AND METHODS: Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs. RESULTS: Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ±â€Š0.97) and irregularity of the scar as the worst (3.82 ±â€Š1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ±â€Š0.97) and stiffness as the worst (3.54 ±â€Š0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ±â€Š0.46, 3.50 ±â€Š0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ±â€Š1.11 and 3.33 ±â€Š1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ±â€Š0.72, 3.66 ±â€Š1.37, respectively, P > 0,05). CONCLUSIONS: Absorbable sutures are a convenient alternative to nonabsorbable sutures. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Long-term Follow-up of Positive Surgical Margins in Basal Cell Carcinoma of the Face.

BACKGROUND: Basal cell carcinoma (BCC) in central facial locations and tumors with positive margins are at a higher risk of recurrence. The most effective treatment is total excision, which includes an adequate pathological margin. OBJECTIVE: To evaluate the outcome of the patients who underwent surgery for BCCs of the head and neck and of those who had positive surgical margins where Mohs surgery is not available. METHODS: This study was conducted at Ege University Medical School between 2004 and 2014. One hundred thirty patients with 154 BCC who underwent surgical excision were included. In the histopathologic report, the existence of positive margin, BCC subtype, localization of the tumor, and distance of margins to the tumor were evaluated. RESULTS: Twenty-three lesions (14.9%) of 22 patients revealed positive surgical margins. Six patients (26.1%) had recurrences on the surgical site. The BCC subtypes of recurrent patients were reported to be multifocal superficial in 2 (33.3%), infiltrative (16.7%) in 1, and micronodular (50%) in 3. CONCLUSION: Patients with superficial multifocal or micronodular tumors should undergo reoperation because of high recurrence rates.

Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech.

The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.

Orbital complications of pediatric rhinosinusitis: A single institution report.

BACKGROUND AND OBJECTIVES: Rhinosinusitis is one of the most common infections of childhood. Rhinosinusitis usually limits itself in the pediatric age group, however orbital and intracranial complications may arise in some of the patients. The purpose of the study was to retrospectively analyse the previous treatments and outcomes in pediatric rhinosinusitis patients with orbital complications. METHODS: The effect and prognosis of medical treatment and endoscopic sinus surgery are reported in this study. Twenty-five pediatric patients diagnosed with complicated rhinosinusitis between January 2008 - February 2016 were included in the study. Orbital complications, examination findings, radiological imaging and blood counts were retrospectively collected from patient files. The duration of hospitalization, source of the infection, complications, previous medical and surgical treatments were also retrospectively assessed. RESULTS: Average age of the patients were 8.84 ± 4.02 years (range: 1-16 years). The mean length of stay in hospital was 6.72 ± 3.28 days. Hospitalization in surgically treated group was higher than primarily medically treated group. However this difference could not reach to a statistically significant level (p > 0.05). Mean hospitalization time was found 5.21 ± 2.51 and 8.43 ± 2.87 days in patients diagnosed with preseptal cellulitis and subperiosteal abscess respectively. Hospitalization in patients with subperiosteal abscess was higher than preseptal cellulitis and a statistically significant difference was detected (p < 0.05). CONCLUSION: Morbidity and mortality of orbital complications which are the most common complications of pediatric rhinosinusitis, could significantly be reduced by using appropriate treatment methods and an early diagnosis. Conservative therapy is an effective method for patients with preseptal cellulitis and most cases of orbital cellulitis in children.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients.

INTRODUCTION: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. OBJECTIVE: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. METHODS: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0±12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. RESULTS: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p=0.004). In both groups the lower turbinate volumes were significantly decreased (p=0.002, p<0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p=0.033). CONCLUSION: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

The role of EGFR overexpression on the recurrence of basal cell carcinomas with positive surgical margins.

BACKGROUND: Epidermal growth factor receptor (EGFR) expression may have role on recurrence of basal cell carcinoma (BCC) with positive surgical margin(s). OBJECTIVE: The aim was to investigate the role of genetic expression changes of EGFR on recurrence rates in patients in follow up with surgically excised BCC with positive surgical margin(s). METHODS: Thirty-four surgical margin-positive BCC lesions that were closely followed up without an immediate reoperation were included in this study. Real-time polymerase chain reaction (PCR) was performed from the both healthy and tumoral tissue samples. RESULTS: EGFR was expressed at a significantly higher rate in tumoral tissues compared to healthy tissues (p < 0,05). In patients with recurrence lesions, EGFR expression was 6,66 times higher compared to patients with non-recurrent. Also, there was statistically significant difference EGFR expression for infiltrative subtypes (p < 0,05). CONCLUSION: Our study focuses on the role of EGFR overexpression specifically and outcomes for recurrent and infiltrative subtyped lesions are significant for both clinic and pathogenesis of BCC. Similar studies have to be performed with high numbered patient groups.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients / Efeitos da turbinoplastia versus fratura lateral e cauterização bipolar no volume da concha inferior hipertrófica compensatória em pacientes submetidos a septoplastia

Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

Resumo Introdução: A causa mais comum de falha da septoplastia é a hipertrofia das conchas inferiores não tratada adequadamente. Diversas técnicas foram descritas até o momento: turbinectomia total ou parcial, ressecção da submucosa (cirúrgica ou com microdebridador) e a fratura lateral. Objetivo: Neste estudo, comparamos os volumes pré e pós-operatório da concha inferior com hipertrofia compensatória com o uso de tomografia computadorizada entre pacientes submetidos a septoplastia e turbinoplastia ou fratura lateral com cauterização bipolar. Método: Este estudo retrospectivo incluiu 66 pacientes (37 homens e 29 mulheres) internados em nosso serviço de otorrinolaringologia entre 2010 e 2017 por obstrução nasal e submetidos à cirurgia por desvio de septo nasal. Os pacientes submetidos à turbinoplastia devido à hiperplasia compensatória da concha inferior formaram o grupo turbinoplastia; aqueles submetidos à fratura lateral e cauterização bipolar foram separados, formaram o grupo fratura lateral. Os volumes compensatórios da concha inferior de todos os pacientes que participaram do estudo (idade média de 34,0 ± 12,4 anos, faixa de 17 a 61 anos) foram avaliados por tomografia computadorizada dos seios paranasais nos planos axial e coronal no pré-operatório e aos dois meses do pós-operatório. Resultados: As dimensões transversais e longitudinais do grupo turbinoplastia no pós-operatório foram significantemente menores do que as do grupo de fratura lateral (p = 0,004). Em ambos os grupos, os volumes da concha inferior diminuíram significantemente (p = 0,002, p < 0,001, respectivamente). O volume pós-operatório da concha do lado do desvio aumentou significantemente no grupo turbinoplastia (p = 0,033). Conclusão: Tanto a turbinoplastia como a fratura lateral são técnicas efetivas de redução de volume. No entanto, a turbinoplastia causa maior redução do volume da concha inferior do que a fratura lateral com cauterização bipolar.